Dental Services Authorization Specialist(Elk Ridge) - Flagstaff Fourth St - General Dentistry

El Rio Health•Flagstaff, AZ

8d•Onsite

About The Position

The Dental Services Authorization Specialist serves as a liaison between the Dental Business Office, in-house providers, external referral sources, and health plans while providing service to Elk Ridge Community Health patients and staff. The role supports the organization’s mission to provide comprehensive, quality health care that is affordable and accessible. The specialist meets with patients to discuss treatment plans, insurance coverage, and financial responsibilities; prepares cost estimates; processes authorization requests and denials; schedules appointments; and provides providers with accurate approvals through the electronic authorization program. The role also assists with staff training and monitors workflow at all sites to help meet department goals and provide customer service to patients, providers, and team members. The position requires maintaining a clean and safe work environment and complying with organizational policies and Joint Commission Certification standards. The specialist also represents Elk Ridge Community Health professionally, may participate in community and health care activities, supports cost-effective use of resources, accurately documents hours worked, and maintains proficiency with the organization’s operating systems and software. Other duties may be assigned. Employees must have reliable transportation that can accommodate operational reassignments during the workday. When driving during work hours, employees must hold a valid driver’s license and comply with Arizona vehicle insurance requirements. Reasonable accommodations may be made for individuals with disabilities. Drug testing is required before employment, with additional testing under specified circumstances. Positions responsible for the safety and welfare of others are classified as safety sensitive.

Requirements

High school diploma or GED.
Three years of experience working in a health care setting with authorizations, insurance coverage and benefits, claims, billing, and customer service.
Three years of experience working with electronic health records (EHR).
Current, valid Level I fingerprint clearance card in good standing, or application for one within seven working days after beginning employment.
Reliable transportation capable of meeting organizational operational reassignments during the workday.
Valid driver’s license and compliance with Arizona vehicle insurance requirements if driving during work hours.
Ability to undergo pre-employment drug testing and applicable post-accident, reasonable suspicion, return-to-duty, and follow-up drug and alcohol testing.
Ability to perform the essential functions of the position, with reasonable accommodations where applicable.

Nice To Haves

Bachelor’s degree in a health care-related field from an accredited college or university.
Dental Assisting Program Certificate (DA III) and/or state certification.
Certified Dental Billing Specialist (CDBS) certification.
Certified Patient Account Technician (CPAT) certification.
Bilingual English/Spanish skills, including the ability to speak, read, and write in both languages.
An equivalent combination of education and experience may be considered if directly related to the job’s functions and responsibilities.

Responsibilities

Demonstrate knowledge of Commercial, Medicaid (AHCCCS), and Medicare insurance plans.
Schedule initial and follow-up appointments for complex treatment, including oral surgery and sedation cases.
Perform authorization and utilization activities for dental insurance plans.
Process authorization claim forms; review ICD-10 diagnostic and CDT procedural codes; and work to overturn denials.
Use billing and coding knowledge to ensure diagnostic and procedural codes are accurate, consistent, and standardized in dental treatment documentation.
Complete, submit, and reconcile authorization claim forms.
Enter data into the electronic health record and specified reports in Excel or Elk Ridge Health systems.
Research, correct, and resubmit denied claims.
Coordinate procedure groupings and submission timeframes for all or part of treatment plans to obtain authorization approvals.
Determine the cost or utilization of grant funds when submitting authorization requests.
Perform general accounting functions.
Meet with patients to discuss treatment plans, insurance coverage, and financial responsibilities.
Submit authorization requests in-house and/or to outside vendors.
Document approvals, denials, and explanations in patient charts.
Inform and educate groups about insurance and authorization changes or new coverage.
Maintain a high level of customer service and address and resolve patient concerns.
Maintain a clean, safe, and hygienic work environment in accordance with policies and procedures, including infection prevention and control requirements.
Demonstrate proficiency with compliance and reporting requirements applicable to Joint Commission Certification standards.
Represent Elk Ridge Community Health professionally and serve as a positive source of information for the community.
Participate in community events and appropriate local, state, and national health care activities that promote health and support the organization’s public image.
Use materials, supplies, and equipment cost-effectively and limit waste.
Accurately document hours worked and obtain timely sign-off or approval.
Maintain proficiency with Elk Ridge Community Health operating systems and software, adapting to changes and learning new skills as systems are upgraded.
Perform other duties as assigned.